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Which program are you applying for?

Oriental Medicine Massage Therapy Program
Acupuncture Training Program
Acupressure /TUINA Therapy Certificate Program
Cupping Therapy Certificate Program
Reflexology Certificate Program
GUASHA/Moxibustion Certificate Program
MBLEX PASS Program
Continue Education
Transfer

Which Campus do you want to enroll in?

AMOM –Southfield
AMOM — Troy

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Nickname/ what your preferred to be called by

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State

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SSN

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If you don’t have a driver license upload your passport or a document with your photo.

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Email Address

Date of Birth

Sex/Gender

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Female
Other
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Country of Birth

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State / Province / Region

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Racial/Ethnic Background

Are you a Citizen of the US or of the US Territories?

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No

If No do you have:

Green Card
F-1 or M-1 VISA
Need an F-1 or M-1 VISA
B1/B2 VISA

IN CASE OF EMERGENCY NOTIFY (NAME):

EMERGENCY PHONE #

Education level

Highschool/ GED
Bachelors
Masters
Doctorate

Upload Your Diploma/Certificate

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Were you enrolled in another US College/School within 12 months of enrollment at AMOM? *

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No

Are you able to completely finance your own education? (tuition, fees, living expenses, transportation, etc.)

Yes
No

If no, would you require a financial support?

Yes
No

What kind of financial support do you want to apply?

when do you want to start?

Which class do you prefer?

Morning class (6 Months)
Evening class with Saturday (8 Months)
Evening class with Monday (8 Months)
Weekend class (12 Months)

Employment and Volunteer Service, please list all paid employment and/or voluntary service for at least the last three years beginning with your most recent:

Names and addresses of three character references. AMOM will send character references forms to those persons listed on the application as references. Those persons should complete the form and return it to the college. Relatives are not accepted as references.

Have you been convicted of a felony?

Yes
No

How did you hear about us?

Google
Facebook/Instagram
Friends/Family
Others

Website/URL

What methods of learning do you believe work best for you? (Check more than one if applicable)Kinesthetic/Tactile/Hands- on Visual Auditory

Please write a brief assessment regarding your academic strengths and weaknesses

This program requires physical participation and some strength. Do you have any limitations* (physical, emotional, mental) that would prohibit you from 100% participation? If yes, please explain

Currently, or in the past, have you had learning challenges, problems with retaining information, or problems applying information? (This would include if you had an I.E.P. in school, or any special accommodations made in your learning environment. Please provide details:

Medical diagnoses (past and present, including, but not limited to: cancer, blood clots, heart disease, diabetes, seizure disorders, pregnancy, injuries, skin conditions, etc.):

Medications, over-the-counter medications, supplements:

Psychological diagnoses and/or psycho-educational test results

Are you aware of any ways the Institute for Massage Education can support your learning needs?

Have you ever received a professional massage? How was that experience for you?

want Citizen Cell

Please describe what it is about becoming a Licensed Massage Therapist that interests you. Additionally, tell us why this is the obvious next step for you

What qualities do you feel you possess that will assist you as a Licensed Massage Therapist?

2. Based on experience, students who’ve built a support network achieve the best schoollife balance. What does your support network look like? This could include transportation, childcare, finances, housing and communications with your workplace and family members.

Overcoming obstacles, both unexpected and anticipated, is vital to your success as a student. Please share an experience where you’ve faced an obstacle, what you learned about yourself, and how to best face them in the future.

Have you ever been convicted of a felony? If yes, please provide details

Have you ever been convicted of a CSC (Criminal Sexual Conduct)? If yes, please provide details:

Signature

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I hereby make Application for Admission to Acupuncture and massage school of Oriental Medicine and certify that all information given on this application is true. $75 application fee is not refundable.

Application Fee

Price: $75.00

As part of the admissions process at the Acupuncture and Massage School of Oriental Medicine (AMOM), applicants are required to pay a one-time, non-refundable application fee of $75. 🔹 Why We Charge an Application Fee: To review and process your enrollment documents To verify eligibility and prerequisites To reserve your spot in the program To initiate student account setup and records 🔹 Important Notes: This fee is non-refundable, even if you decide not to enroll. The payment is required to complete your application. Payment must be made online via secure credit card (powered by Square). Once your payment is submitted, our admissions team will review your application and contact you within 24 Hours.

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Acupuncture and Massage School of Oriental Medicine

AMOM southfield Campus

AMOM TROY Campus

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